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The Research Question

This research investigates how quickly depressed patients improve with Collaborative Care Management compared to usual care. Results show CCM yields faster symptom improvement, emphasizing the importance of treatment speed. The study, conducted on a large patient cohort, highlights the benefits of CCM within the first month of treatment. However, the non-randomized nature of the study raises concerns about potential biases. Survival analysis emerges as a valuable tool for comparing chronic disease treatments over time.

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The Research Question

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  1. The Research Question Clinical Effectiveness of Collaborative Care Management For Depression Over Time Garrison, GM; Angstman, KB; O’Connor S; Williams MD; Lineberry TW • How much more quickly do depressed patients treated with Collaborative Care Management (CCM) improve when compared to usual care (UC)? • Why this is important? • We know CCM is superior to UC at 6 and 12 months • But, patients care about how quickly treatments improve symptoms • Survival analysis can tell us how quickly patients treated with CCM vs. UC improve

  2. What the Researchers Did • Retrospective Cohort of 7,340 patients diagnosed with major depression or dysthymia from 3/08-6/13 • Taken from primary care practice of over 100,000 • Bipolar disorder excluded • Enrollment in CCM was patient/primary MD decision • Survival Analysis of subsequent PHQ-9 scores • Remission: PHQ9 < 5 • Persistent Depressive Sx: PHQ9 >= 10

  3. What the Researchers Found Median Time-to-Remission (p<0.001) CCM: 86 d (95% CI: 81-91) UC: 614d (95% CI: 565-692) Median Time-with-PDS (p<0.001) CCM: 31 d (95% CI: 30-33) UC: 154 d (95% CI: 138-182)

  4. What This Means for Clinical Practice • Patients care about how quickly they improve • CCM shows improvement over UC within 1st month • Non-randomized study may be biased due to self-selection and sampling • Survival Analysis may be superior to Logistic Regression at fixed endpoint for comparison of many chronic disease treatments

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